Heart Atria – ABC CARDIOL

IJCS

Case Report

Six-Year Follow-Up of an Octogenarian With a Left Atrial Myxoma: Case Report

Miguel Bernardino Antunes Vicente et al. Tânia Amaro Elsa Fernandes

Abstract

Myxoma is the most common primary cardiac tumour, especially in adults. However, reports on this nosological entity in patients over the age of 80 are scarce in the medical literature. Echocardiography is a useful diagnostic tool for detecting cardiac myxomas. These tumours are usually surgically removed soon after diagnosis, limiting knowledge of their natural evolution. In this report, we describe the case of an 86-year-old woman who had been followed irregularly for arterial hypertension since 2016, when an echocardiogram showed a left atrial myxoma adhered to the interatrial septum, initially without impairment of the mitral valve (MV) or obstruction of the pulmonary veins (PV). The patient refused surgical removal at the time. Six years later, she was hospitalized for urinary sepsis. A new echocardiogram revealed an increase in the size of the myxoma, which occupied around 80% of the left atrium (LA), obstructing the PV and MV. New suggestion of surgery was refused by the patient.

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IJCS

Review Article

Transcatheter Interatrial Shunts for the Treatment of Heart Failure with Preserved Ejection Fraction

Anju Bhardwaj et al. Vishal Y. Parikh Ajith Nair

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome, which accounts for about 50% of patients with heart failure (HF). The morbidity and mortality associated with HFpEF is similar to HFrEF. Clinical trials to date have failed to show a benefit of medical therapy for HFpEF, which may due to lack of uniform phenotypes and heterogeneous population. In addition, medical therapy proven for HFrEF may not address the pathophysiologic basis for HFpEF. Left atrial remodeling and dysfunction is central to HFpEF and accounts for secondary pulmonary hypertension and pulmonary vascular congestion that frequently occurs with exertion. Interatrial shunts represent a novel treatment modality for HFpEF. These shunts allow for left atrial decongestion and a reduction in pulmonary venous hypertension during exercise leading to improvements in hemodynamics, functional status and quality of life. Trials to date have demonstrated safety and short-term efficacy of these devices for HFpEF. The long-term benefits are currently being evaluated in ongoing trials. If effective, the use of interatrial shunts may be a new therapeutic paradigm for the treatment of HFpEF.

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IJCS

Original Article

Increased Left Atrial Volume and Its Relationship to Vitamin D in Primary Care

Erica de Abreu Macedo et al. Maria Luiza Garcia Rosa Antônio José Lagoeiro Jorge Adson Renato Leite … Leivys Henrique Silva Santos Juliana Salge Vieira

Abstract

Background:

The study is based on the fact that left atrial (LA) volume measurement is a marker of the presence of diastolic dysfunction and that Vitamin D deficiency may be associated with ventricular remodeling, worsening of left ventricular (LV) diastolic and systolic function, and activation of the renin-angiotensin-aldosterone system.

Objective:

To evaluate whether LAV changes are related to vitamin D deficiency.

Method:

A cross-sectional, population-based, unicentric study in which 640 patients over 45 years of age enrolled in the Niterói’s Médico de Família program, RJ, were evaluated. Patients were submitted to tissue Doppler echocardiography to evaluate the parameters of diastolic and systolic function and vitamin D dosage. The presence or absence of hypovitaminosis D associated with structural and functional cardiac changes was compared between each group. A p < 0.05 value was considered as an indicator of statistical significance.

Results:

Of the 640 individuals analyzed, hypovitaminosis D was confirmed in 39.2% of the patients, of whom 34.8% had diastolic dysfunction. The most relevant echocardiographic parameters that were statistically significant were non-indexed AEDs and LAV, E’/A’ and E wave deceleration time, which were associated with the presence of hypovitaminosis D (P < 0.01).

Conclusion:

The study of the association of hypovitaminosis D and the appearance of structural and functional cardiac abnormalities may contribute to the discussion of the adoption of one more criterion to select individuals at risk of developing clinical cardiac insufficiency in primary care since, with the use of echocardiography, the subclinical condition of cardiac involvement, with prognostic and treatment implications for the referred patients with hypovitaminosis D, can be identified early.

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IJCS

Original Article

Does Percutaneous Left Atrial Appendage Closure Affect Left Atrial Performance?

Marta Madeira et al. Rogério Teixeira Liliana Reis Paulo Dinis … Luís Paiva Ana Botelho Marco Costa Lino Gonçalves

Abstract

Background:

Percutaneous left atrial appendage (LAA) occlusion may be an alternative therapy for atrial fibrillation (AF) patients with contraindication for anti-coagulation therapy. However, the influence of LAA occlusion on left atrial (LA) performance has not been studied.

Objective:

Our aim was to evaluate the influence of percutaneous LAA occlusion device on LA function by transthoracic echocardiography plus speckle-tracking echocardiography (STE).

Methods:

We included 16 patients undergoing percutaneous LAA closure with adequate echocardiographic window for the study of LA mechanics. Transthoracic echocardiography was performed before and after the procedure. LA volumes were calculated using the biplane method, and LA mechanics were assessed using STE. The analysis focused on the LA reservoir phase strain and strain rate.

Results:

Seventy-five percent of patients had permanent atrial fibrillation. Embolic and bleeding risk scores used were CHA₂DS₂-VASc [median of 4-5] and HAS-BLED [median of 2-3]. Major bleeding (62%) was the most common indication for the procedure. Percutaneous LAA closure was performed successfully in all patients, without major complications. No differences were found in maximum LA volume (44 ± 11 vs. 46 ± 13 mL/m²; p = 0.54), minimum LA volume (32 ± 8 vs. 37 ± 14 mL/m²; p = 0.09) or LA emptying fraction (26 ± 17 vs. 21 ± 14%; p = 0.33) before and after the procedure. Similarly, no differences were noted in left atrial strain (13.7 ± 11.1 vs. 13.0 ± 8.8%; p = 0.63) or strain rate (1.06 ± 0.26 vs. 1.13 ± 0.34 s^-1; p = 0.38) in the reservoir phase.

Conclusions:

Our data suggest that percutaneous LAA closure does not affect LA reservoir function.

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Six-Year Follow-Up of an Octogenarian With a Left Atrial Myxoma: Case Report

Abstract

Transcatheter Interatrial Shunts for the Treatment of Heart Failure with Preserved Ejection Fraction

Abstract

Increased Left Atrial Volume and Its Relationship to Vitamin D in Primary Care

Abstract

Background:

Objective:

Method:

Results:

Conclusion:

Does Percutaneous Left Atrial Appendage Closure Affect Left Atrial Performance?

Abstract

Background:

Objective:

Methods:

Results:

Conclusions:

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